Claims Team Lead

Role Description

Claims Team Lead

Lead II – BPM

Who We Are

Founded in 2016, we’ve become a trusted and valued partner for health plans and providers. We offer a modern integrated ecosystem of healthcare operations, processes, and products, with inherent scalability, efficiency, and predictable outcomes. Our BPaaS delivery solutions work behind the scenes to manage our customers’ complex admin operations, giving them elbow room to focus on their members’ needs and well-being.

Bending cost curves, guaranteeing outcomes, finding paths through roadblocks – that’s our way of life. Our customers count on us to safely navigate them through deadlocks. We have a strong global presence and a dedicated workforce of 4000+ people spread across the world.

Our brand is built on strong foundations of simplicity, honesty, and leadership, and we stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.

You Are

UST HealthProof is looking for Claims Team Lead, reporting to the Claims Manager. The Claims Team Lead is responsible for a team of 12-15 claims examiners, adjusters, extensive interaction with client organization, and multiple stakeholders. The Claims Team Lead is accountable for delivering a high-quality claims operation, meeting and exceeding all service level agreements and KPIs, driving operational excellence, and building competencies for delivery.

The Opportunity

• Be responsible for directly managing a staff of 12 - 15 associates
• Be responsible for knowing and meeting client-specified guidelines
• Be responsible for monitoring and management of the downline staff’s productivity targets and financial and procedural accuracy standards as established by management
• Collaborate on special projects as assigned by the manager; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by management
• Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality
• Assemble and assign projects that may include provider data, authorizations, enrolment, or other information
  
  

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need

• Solid understanding and ability to effectively lead a claims team
• 5+ years healthcare claims processing experience
• Good communication skills (verbal and written)
• ICD-10 CPT and HCPCS coding is a plus
• Knowledge base of physician billing and hospital coding (ICD-10, HCPC, CPT-4), medical terminology, and authorization requirements
• Willingness to learn new skills
• Team collaborator
• Strong work ethic
• For this role, we value:
• The ability to adapt quickly to a fast-paced environment
• A self-starter and quick learner
• Team player with an ability to collaborate
• Ability to coach the team to reach their full potential
  
  

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by applicable law, UST provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Remote

Compensation Range: $50,000-$62,000

Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits.

What We Believe

At UST HealthProof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serves as a compass guiding every action and decision.

Guiding Principles

These principles illuminate the path of ‘how’ we operate. They detail actions and behaviors we much embody to honor our values and achieve our goals.

Integrity

Integrity is our currency to build relationships. We believe in being open and honest. It is only natural when we have nothing to hide. It demonstrates that we are here to do the right thing, no matter who is watching.

People-Centricity

Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and decisions, affirming that our true value lies in the lives we touch and impact.

Simplicity

Simplifying complexity underlines everything we do - this approach is what makes us unique. We come with an open mind and straightforward approach, cutting our way to the core with measurable and actionable insights.

Leadership

Taking ownership is about taking initiative, being in-charge and driving things to completion. It’s a brave choice to ‘own’ all aspects of our work, ensuring we take full responsibility for everything we handle.

Mission

A future possible only when health plans are free from administrative burdens so they can truly focus on what matters more – their members’ well-being.

#Healthproof

#CB

Skills

Healthcare,Claims Processing,Claims Management